Permit ' tr • .
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y- CITY OF TIGARD .ELECTRICAL PERMIT
4; DEVELOPMENT SERVICES PERMIT ;* o ELC97-1Z1727
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- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE I SSUED o 11/04/97
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PARCEL: 2S110DD- 140210
SITE ADDRESS.. - 2 10650 SW SUMMERFIELD DR
SUBDIVISION - SUMMERFIELD ZONINGeR -7
LLOCK.- .-- .,_..- - LOT- ,,...... - - -.. 000B JURISDICTIONo TIG
Project Description Add three (3) branch circuits to existing club house
facilities. .
--RESIDENTIAL UNIT---- -.--- -TEMP SRVC/FEEDERS-- -- -... - - -- MISCELLANEOUS- _..___..
1 000 SF OR LESS- - - - 2 0 0 -.- 200 amp... - - - - e 0 PUMP /IRRIGATION e
EACH ADD' L 500SF... o 0 ' 201 -- 400 amp- .. , - 2 0 SIGN /OUT LINE LTG. - 2 0
LIMITED ENERGY - 0 401 - 600 amp ° 0 SIGNAL/PANEL.......: 0
MANF„ HM/ SVC /FDR- . e 0 SOH-amps-1000 volt s. e 0 MINOR LABEL (10) - .. e 0
----SERVICE/FEEDER---- - - - -- BRANCH CIRCUITS- -• - - -- ---ADD' L. INSPECTIONS---- -
0 - 200 amp. - -...0 0 W /SERVICE OR FEEDER: 0 PER INSPECTION ° 0
201 - 400 amp..... - e 0 1st W/O SRVC OR FDR.: 1 PER HOUR e 0
401 •-• GOO amp. - - - .. - 2r EA ADD' L BRNCH CI RC o 2. • IN PLANT. „ „ .... - ... - 0
601 - 1 000 amp. - o - „ 2 0 -- _._- ___- _- _-- __.- .- 'PLAN' REVIEW SECTION- - _.__...._.- _._
1000+ amp/volt..... o 0 ) =4 RES UNITS. - . - o .. a ) GOO VOLT ' NOMINAL.. e
Reconnect only - 0 SVC /FDR 5= 225 AMPS..: CLASS AREA /SPEC OCC.
SUUMERFIELD CIVIC ASSOCIATION type amount by date recpt
10650 SW SUMMERFIELD DRIVE PRMT $ 45.00 GEO 11/04/97 97- -300 •_7 -
TIGARD OR 97223 5PCT $ 2.25 GEO 11/04/97 97- 300627
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Phone #:
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Contractor 2 ---------------.---- _ - .._.,--- •---------- • -•• -- -
WESTSIDE ELECTRIC 47.25 'TOTAL_ '
7518 SW MACADAM AVE . •
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--- - - -• -- REQUIRED INSPECTIONS - - -___ _.-
PORTLAND OR 97219 Ceiling Cover Underground Cove
Phone #a 245 -3385 Wall Cover Elect' 1 Service
Rev Tt v n e 000133
This peroit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other
applicable laws. All work Will be done in accordance with approved plans. This peroit will expire if work is not started within 180
days of 'issuance, or if Work is suspended for gore than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -201 -1987. You say obtain a copy
of these rules or direct questions to OUNC by calling (503)246-1987.
Permittee Signature: _ Issued By: — _ _• _
- -OWNER INSTALLATION is1NLY-.-.----•-----------•------...--_._-.------.-_--
The installation is 'being made on. property I on which is not intended for •
safe, •ease„ or' rent. .. . ,
OWNER'S SIGNATURE; DATE e . ' --
------------ .----- .- ...----- ..-- .-- • - -• - -- CONTRACTOR INSTALLATION ONLY--- . _.__ -. -._. 7 . .
SIGNATURE OF SUPR, EL_EC' No �� - DATES j./.46? —
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-1 -1- •i— q—q—i--r- -•--4-1--h-r.. {- l- q-4- +•-t- -1- -1- +i• 4 i--Fi - I ++ 4—F-FA , - , r4- — i-.4....h•-t -1- -l-,I-4- -'r•;-•Y•i- ;...4.;.A..A--h4.... }--F l--r°-I- +i-
Call 639- -4175 by 7200 pv m. for~ an inspection needed the next business day
+ +-L.. + +-: - F• ••_r_••r--I••-F-r_•Z••-f... }... F...+. r..- i....._ r•-:-±.. F- f.-• i_- {-_I__F_}•1L_r...J--f+Jf-F.Li ++.- r•.-r...r..4 -4 - 4- 1- •'I- -I-•1--1--r ;•+++• + ++ :-+ :-i-. {-. }-}-+••r--i--F-F-' +-i•
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 Print or Type Date to DST
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit # Of---e 9
Fax (503) 684 -7297 Called
1. Job Address: / / 4. Complete Fee Schedule Below:
Name of Development U/ / e/ Number of Inspections per permit allowed
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Name (or name of business /!Uurffr � C. 1$ I C/!( /Jt Service included: Items Cost Sum
/ ' -
Address O j2. .J 1 /l7 /�/ / 27� 4a. Residential - per unit
City /State /Zip
�j, Q` Ok 972z7 (/ 1000 sq. ft. or less $110.00 4
, / � / El Li Each additional 500 sq. ft. or
Commercial E Residential portion thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all curren li. =ns ) ,, /, • 4b. Services or Feeders
Electrical Contrac or . ' • / / f AC Installation, alteration, or relocation
Addres , % 200 amps or less $60.00 2
f �p� «� €2',-;-1. � v�Ti ' � 201 amps to 400 amps $80.00 2
City L�JA,/ State 0 Zip 4 401 amps to 600 amps $120.00 2
Phone No. • 2 41S -33tr 601 amps to 1000 amps $180.00 2
Job No. /U ? 01- 00 V Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. n-/3,c(__ Exp.Date
OR State CCB Reg. No. /370 6 Exp.Date 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n_ 201 amps to 400 am $75.00 2
401 amps to 600 amps $100.00 2
-�/ Over 600 amps to 1000 volts,
License No �. [ Tf .J Exp.Date see "b" above.
Phone No. 2 VS =3 3 seS
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circ $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit / J
$35.00 __ 2
The installation is being made on property I own which is not Each additional branch circuit Z $5.00 / U 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units In one structure 4f. Each additional Inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: L
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $
NOTICE Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtyfe $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY / 3 Co L/ -C
TIME AFTER WORK IS COMMENCED. 1_I Trust Account # wW
Total balance Due $
Te.i
1: \DSTS \ELC96.APP Rev 9/96
RECEIVED
NOV 0 3 1997
COMMUNITY DEVELOPMENT